Provider Demographics
NPI:1568632537
Name:THE CHILDRENS CAMPUS, INC
Entity Type:Organization
Organization Name:THE CHILDRENS CAMPUS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ERMETI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-259-5667
Mailing Address - Street 1:1411 LINCOLNWAY W
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46544-1626
Mailing Address - Country:US
Mailing Address - Phone:574-259-5666
Mailing Address - Fax:
Practice Address - Street 1:526 LINCOLNWAY E
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-2212
Practice Address - Country:US
Practice Address - Phone:574-259-7797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN42256320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness